Challenge

How might we help the dermatology team handle the continously increasing number of referrals?

Approach

Co-design with Dermatology team, General practitioners and medical schools

Outcome

Reduction of routine dermatology wait list by establishing alternative care pathways 

'It’s like we’re caught in a tsunami of patient referrals.'

— Dermatology Consultant in the Mater Hospital, 2024

The global rise in dermatology cases, especially skin cancers, is stressing healthcare systems globally. This trend can be observed in Ireland, with 58,009 dermatology outpatients on the waiting list nationally. The Mater Hospital alone accounts for 5% of the national dermatology waitlist.

There are over 3,000 patients awaiting initial dermatology outpatient appointments in the Mater Hospital, the 2nd highest medical specialty and the 4th overall specialty. (National Purchase Treament Fund, Jan 2025)

Problem definition

This project identified several challenges that the Mater Hospital Dermatology Department is facing: 

Problem #1 Capacity for appointments exceeding
Dermatology clinics are overwhelmed by the surge in cases, resulting in longer waiting lists and delayed care.

Problem #2 Longer wait times for routine patients
Continuing prioritisation of urgent cases has led to even longer wait times for routine dermatology patients.

Problem #3 General practitioners referring mainly urgent cases
Cases that are typically triaged as 'routine' by dermatologists are often being referred as 'urgent' by GPs. 

Design research

How might we support General Practitioners to manage common (triage category: routine) skin conditions in the community?

Co-design workshop with 22 General Practicioners, 2023

Education 

 Alternative pathways 

 Communication 

Asking the poeple who know best – General Practitioners. 

In light of the problem identified through project analysis, it became essential to understand the perspectives of both hospital dermatology and primary care practitioners. With direct access to the dermatology team throughout the research phase, it became invaluable to engage with General Practitioners (GPs).

In addition to individual interviews, we recruited 22 GPs for a focused two-hour session to explore potential solutions. During this session, participants took part in a dot-voting exercise to prioritize the most promising options for trial.

Developed interventions

1 

Education 

SimU Skin teaching aid

High fidelity models of skin conditions have been incorporated into a book set that will transform how Dermatology is taught. These silicone models enable General practitioners as well as medical and nursing students to appreciate aspects such as surface texture, colour and depth of colour.

2

 Alternative pathways 

Siilo Advice channel

Using the established Doctolib Siilo messenger in the hospital as a quick channel out into the community. General Practicioners are able to send on photos of routine dermatology conditions they are uncertain about to seek advice from the specialists in the hospital. 

3

 Communication 

Active Discharge Letter

These new forms of letters assist dermatologists in the hospital by streamlining the process of managing routine cases, quickly generating a Dermatology care plan for patients to be passed on to General Practicioners in the community for further consultation.

1 SimU Skin teaching aid

WHAT IT IS FOR 

• Teaching tool designed to enhance the identification of skin conditions, from inflammation to infections to tumors by simulating actual skin textures
• Featured detailed silicone skin models cover 26 conditions across 14 booklets, that offer realistic visuality and tactile feedback

IMPACT 

• Improved dermatology learning outcomes for nursing and medical students (UCD IRIS, the School of Nursing and the Mater Hospital)
  → Researched study
• Finalized product ready for non-profit sale across teaching facilities in Ireland

MY ROLE

• Stakeholder Research (GPs, Medical students, Dermatologists)
• Development and design of the physical set of booklets holding the skin models, condition related content + labeling of models
• Facilitating printing and publishing process
• Marketing of finalised product (website & social media)
  

2 Siilo advice channel

WHAT IT IS FOR 

• A direct communication channel between community care and dermatologists at the Mater
• Aims to keep routine dermatology care within the community, reducing the need for referrals
• Facilitates encrypted messaging of patient information and high-quality photographs of skin conditions

IMPACT 

• Piloted with selected GPs in the hospital’s catchment area and social inclusion hubs to test feasibility and refine the process
• Led to the establishment of a remote Siilo outpatient clinic, operated one day a week
• Improved photo quality, enabling faster and more accurate diagnoses 
• Increased confidence and reassurance among General Practitioners

MY ROLE

• Service development from scratch in collaboration with Dermatology Consultants and Registrars
• Led the pilot testing, gathering feedback from GPs and iterating on the process
• Conducted observations and shadowed primary care facilities, along with conducting in-depth interviews

3 Active Discharge Letter

WHAT IT IS FOR 

• Templates for discharge letters related to routine dermatology patient referrals to the Mater
• Letters that provide actionable suggestions for further patient care in the community.

IMPACT 

• Pre-populated Active Discharge Letters save doctor's time in clinic 
• Provides GPs with actionable treatment plans, rather than generic rejection letters
• Offers patient-specific, editable templates with multiple treatment options (A, B, C plans)

MY ROLE

• Designed and developed the functionality of the Active Discharge Letters (across 7 iterations)
• Integrated the letters within the hospital system
• Led co-design sessions with Consultants to refine the process
• Collected feedback from GPs to improve the system